Tacrolimus-Induced Acute Esophageal Necrosis Postorthotopic Liver Transplantation

Acute esophageal necrosis, or "black esophagus," is a rare but severe condition characterized by circumferential black necrotized esophageal mucosa with an abrupt transition at the gastroesophageal junction. The "two-hit" hypothesis suggests that an initial ischemic insult predisposes the esophageal mucosa to further injury from luminal acid exposure or medications. We present the first documented case of tacrolimus-induced acute esophageal necrosis without preceding hemodynamic instability in a liver transplant recipient, which resolved with discontinuation of tacrolimus and transition to cyclosporin.